Treatments for Pregnancy Sickness

You Deserve Treatment

One of the biggest barriers to treating pregnancy sickness is the widespread myth that no medication is safe during pregnancy. This is simply not true. Several antiemetic (anti-sickness) medications have been used in pregnancy for decades with excellent safety records. NICE (the National Institute for Health and Care Excellence) explicitly recommends offering medication when non-pharmacological approaches are insufficient.

Not treating severe pregnancy sickness carries its own risks — dehydration, malnutrition, electrolyte imbalance, and significant mental health harm. The risks of treatment are almost always lower than the risks of leaving severe sickness untreated.

First-Line Medications

These are the medications most commonly prescribed as first-line treatment for pregnancy sickness in the UK:

Medication	Type	How It Works	Common Side Effects	Notes
Cyclizine	Antihistamine	Blocks histamine receptors in the vomiting centre	Drowsiness, dry mouth	Often first choice in the UK. Available as tablets or injection.
Promethazine (Avomine)	Antihistamine	Similar to cyclizine with additional sedative effect	Drowsiness (can be significant), dry mouth	Useful if sickness is worst at night. Available over the counter.
Prochlorperazine (Stemetil)	Phenothiazine	Blocks dopamine receptors in the chemoreceptor trigger zone	Drowsiness, restlessness (rare)	Available as tablets, buccal tablets (dissolve on gum), or injection.
Metoclopramide (Maxolon)	Dopamine antagonist	Speeds gastric emptying and blocks the vomiting centre	Drowsiness, restlessness	Usually limited to 5 days at a time. Effective for nausea with bloating.

Second-Line Medications

If first-line medications aren't sufficient, these may be prescribed:

Medication	Type	Notes
Ondansetron (Zofran)	5-HT3 antagonist	Very effective antiemetic originally developed for chemotherapy patients. Used extensively in pregnancy, particularly for HG. Some studies suggest a very small increased risk of cleft palate in the first trimester (approximately 3 extra cases per 10,000 births). Discuss with your doctor. Often life-changing for severe HG.
Domperidone (Motilium)	Dopamine antagonist	Speeds gastric emptying. Less likely to cause drowsiness than metoclopramide. Available as tablets or suppositories (useful when you can't keep tablets down).
Corticosteroids	Steroid	Reserved for severe, refractory HG that hasn't responded to other treatments. Usually started in hospital. Effective but carry more significant side effects. Not used in the first trimester unless absolutely necessary.

Vitamins and Supplements

Vitamin B6 (Pyridoxine)

Vitamin B6 has some evidence for reducing nausea in pregnancy, particularly at doses of 10-25mg three times daily. It is recommended as a first step in several international guidelines (particularly in the US and Canada). It's available without prescription. Side effects are rare at recommended doses. It can be taken alone or combined with an antihistamine like doxylamine (this combination is the standard first-line treatment in North America).

Thiamine (Vitamin B1)

Thiamine supplementation is important for any woman who has been vomiting frequently or unable to eat for extended periods. Thiamine deficiency can lead to Wernicke's encephalopathy — a serious and preventable neurological condition. If you're admitted to hospital with HG, thiamine should always be given alongside IV fluids.

Folic Acid

Continue taking folic acid (400 micrograms daily) if you can keep it down. If not, discuss alternatives with your midwife — some women tolerate different brands or formulations better. Your body's stores will provide some protection even if you can't take supplements consistently in the first trimester.

Non-Medication Approaches

These may help mild to moderate symptoms. They are rarely sufficient for severe NVP or HG, but can complement medication:

Acupressure

Pressure on the P6 (Nei-Kuan) point on the inner wrist has some evidence for reducing nausea. "Sea-Band" wristbands apply continuous pressure to this point. They're drug-free, cheap, and have no side effects. Evidence is mixed but many women find them helpful, particularly for mild nausea. Worth trying as a complement to other treatments.

Ginger

Ginger has some evidence for reducing mild nausea. It can be taken as ginger tea, ginger biscuits, ginger ale (flat), or capsules (250mg four times daily is the studied dose). It's generally safe in pregnancy. However, it is not a treatment for moderate to severe sickness and should never be offered as a substitute for medication when medication is needed.

Dietary Adjustments

• Eat small amounts frequently rather than large meals
• Keep plain crackers, breadsticks, or dry toast by your bed — eat before getting up
• Avoid cooking smells (cold foods often tolerated better than hot)
• Sip fluids between meals rather than with meals
• Eat whatever you can tolerate — nutrition can be improved later
• Ice lollies and frozen fruit can help with hydration when drinking is difficult

What to Say to Your GP

If you're struggling to get treatment, here are phrases that may help:

• "I am unable to keep fluids down and I'm concerned about dehydration."
• "My sickness is preventing me from caring for myself/my children/working."
• "I understand that antiemetics are recommended by NICE for pregnancy sickness. Can we discuss which one would be appropriate for me?"
• "I have lost [X] kg since becoming pregnant."
• "My urine is very dark/I haven't urinated for [X] hours."
• "I would like my ketones tested."
• "This is significantly affecting my mental health."

Treatment Ladder

Treatment should be stepped up progressively based on symptom severity:

1. Mild: Dietary changes, ginger, acupressure, vitamin B6
2. Moderate: First-line antiemetic (cyclizine, promethazine, or prochlorperazine)
3. Moderate-Severe: Combination of antiemetics (e.g., cyclizine + metoclopramide)
4. Severe/HG: Ondansetron (alone or combined), IV fluids if dehydrated
5. Refractory HG: Corticosteroids, regular IV fluid infusions, possible NG tube feeding in extreme cases